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Abstract
Individuals in treatment for substance use continue to smoke at higher rates than the general population of the United States. This editorial presents a different perspective on cigarette smoking that might reflect aspects of the subculture of individuals who, representing a heterogeneous population, smoke while recovering from substance use associated problems. We discuss factors that independently and, in combination, influence cigarette smoking during treatment and recovery from substance use. We conclude that more qualitative research is needed to understand which factors, not typically emphasized in standard tobacco cessation programming, may contribute to cigarette smoking cessation for this population.
GLOSSARY
Disinhibition: A lack of restraint, an inability to think through the consequences of actions, or a prioritizing of short over long-term goals.
Normie: A term used by individuals in recovery for alcohol or substance use disorders to identify those with no experience with substance use treatment or alcohol/drug use.
Outsider group (aka “out group”): Possessing characteristics, behaviors, values, and world-views that are uncommon among one's peers.
Rebellion: Open defiance of, or resistance to, an established authority structure, and exhibiting behaviors that support such defiance or resistance.
Resistance: A global trait with many facets governing social interactions, behaviors, and the cognitive appraisal of events.
Notes
1 The reader is reminded that the diagnosis of a “substance use disorder” (SUD) is a relatively new diagnosis which is based upon a consensus-based taxonomy (American Psychiatric Association: Washington, DC, Diagnostic and Statistical Manual of Mental Disorders (DSM-V), 5th Ed.; 2013) In order that any diagnosis be useful for treatment planning it should “offer,” minimally, three critical, necessary types of information: etiology, process and prognosis…which are not always known. Second, a diagnosis, when demystified, is simply the outcome of a reliable and relevant information-gathering process to be used for necessary decision making. Third, the underpinnings for diagnostic criteria can be theory-driven, empirically-based, individual and/or systemic stake holder-bound, based upon “principles of faith”, etc. All-too-often the needs or agendas of the classifier (individuals as well as systems) are not adequately considered or noted. Lastly, whereas all diagnoses are taxonomy categories or labels, all labels are not diagnoses. The SUD, given all of the aforementioned, may be a flaw and a barrier to effective intervention planning. Editor's note.
2 The reader is asked to consider the implications of such “concern” rarely being translated into tobacco use being a focus in most “specialized addiction” treatment programs, whatever their ideological positions and identification. A conceptual flaw? Editor's note.
3 Treatment can be briefly and usefully defined as a unique, planned, goal directed, temporally structured, multi-dimensional change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.), associated with a range of stakeholders with agendas, and can be categorized into professional-based, tradition-based, mutual-help based (AA,NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which aren't also used with nonsubstance users. Whether or not a treatment technique is indicated or contra-indicated, and what are its selection underpinnings (theory-based, empirically-based, “principle of faith-based, tradition-based, etc.) continues to be a generic and key treatment issue. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) and wellbeing treatment-driven models there are now new sets of goals in addition to those derived from/associated with the older tradition of abstinence driven models. Conflict-resolution models may stimulate an additional option for intervention. Each ideological model has its own criteria for success as well as failure as well as iatrogenic-related harms. Treatment is implemented in a range of environments; ambulatory as well as within institutions which can include controlled environments. Treatment includes a spectrum of clinician–caregiver patient relationships representing various forms of decision-making traditions/models; (1) the hierarchical model in which the clinician-treatment agent makes the decision(s) and the recipient is compliant and relatively passive, (2) shared decision-making which facilitates the collaboration between clinician and patient(s) in which both are active, and (3) the “informed model” in which the patient makes the decision(s). Editor's note
4 The reader is referred to Hills's insightful criteria for causation which were developed in order to help assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes or merely associated. (Hill, A. B. (1965). The environment and disease: associations or causation? Proceedings of the Royal Society of Medicine 58: 295–300.). Editor's note.
Additional information
Notes on contributors
Timothy J. Grigsby
Timothy J. Grigsby, B.A.,US, is a doctoral student in Preventive Medicine at the University of Southern California, Keck School of Medicine. His research focuses on adolescent and young adult health behaviors with an emphasis on the conceptualization, measurement, and determinants of problem alcohol/drug use.
Myriam Forster
Myriam Forster, MPH, US, is a doctoral student in Preventive Medicine at the University of Southern California, Keck School of Medicine. The focus of her research is the etiology of interpersonal violence and violence-related behaviors. She has a particular interest translational research that can improve prevention strategies in community-level care settings.
Steve Sussman
Steve Sussman, Ph.D., FAAHB, FAPA, US, received his doctorate in social-clinical psychology from the University of Illinois at Chicago in 1984. He is a professor of preventive medicine, psychology, and social work at the University of Southern California (USC), and he has been at USC for 30 years. He studies etiology, prevention, and cessation within the addictions arena, broadly defined. He has over 460 publications. His programs include Project Towards No Tobacco Use, Project Towards No Drug Abuse, and Project EX, which are considered model youth prevention or cessation programs at numerous agencies (i.e. CDC, NIDA, NCI, OJJDP, SAMSHA, CSAP, Colorado and Maryland Blueprints, Health Canada, U.S. DOE, and various State Departments of Education). He received the honor of Research Laureate for the American Academy of Health Behavior in 2005, and he was President there (2007–2008). Also, as of 2007, he received the honor of Fellow of the American Psychological Association (Division 50, Addictions). He is the current Editor of Evaluation & the Health Professions (SAGE Publications).